Background Post-traumatic stress disorders (PTSD) pose a high burden for individuals and societies. Although prevalence rates are rather low, high co-occurrence rates and overall impairments cause deleterious suffering and significant costs. Still, no long-term data on costs and trends in cost developments are available. Methods Claims data from a German research database were analysed regarding direct and indirect costs occurring for individuals with incident diagnoses of PTSD. Results were compared to non-exposed average insurants matched on age and gender. Costs were analysed over a 5-year period from 2 years preceding until 3 years following an incident diagnosis of PTSD. Results Overall costs for PTSD account for approximately 43,000 EUR per individual, which is three times higher than costs for non-exposed controls. Of these costs, 59% are caused by mental disorders, 18% specifically by PTSD. In the control group, costs for mental disorders account for 19% of total costs. Costs increase by 142% in the year after an incident diagnosis of PTSD but return to the initial level 2 years later. Still, costs are at least twice as high in every year as in those for the comparison group. Conclusions Individuals with PTSD seem to suffer from far more impairments in their general health conditions and incur many more costs than average insurants. Most of these seem to be caused by co-occurring mental disorders and show their maximum in the index year. Nevertheless, as costs decrease to their initial level, treatments seem to have counterbalanced the impairments due to PTSD. Thus, treatments for PTSD can be considered as beneficial and their cost-effectiveness should be further investigated.
Objective: Anorexia nervosa (AN) and bulimia nervosa (BN) impose a significant financial burden and immense sufferings on affected individuals. Yet little is known about the differences between how each disorder affects males and females, respectively.Method: We performed a retrospective cost-development analysis of anonymized claims data from the German statutory health-insurance system. Insured persons who suffered from an onset of AN (F50.0; N = 1,242 females and 71 males) or BN (F50.2; N = 1,104 females and 64 males) were analyzed for cost-of-illness over a 5year period, beginning 2 years before the index diagnosis. Results:In total, all groups incurred similar distributions of total costs over the 5-year observation period, with roughly 14,000-20,000 EUR median costs. About two-thirds of the total costs for females and males with AN are associated with mental illness, whereas for females and males with BN, this applies to approximately half the total costs. Analyses revealed differences between disorders and genders for single outcomes. AN is associated with a stronger increase in costs within a short period following onset and higher inpatient treatment costs, whereas BN entails more instances of incapacity to work before and after onset. Compared to females, males incurred lower costs in outpatient treatments.Discussion: Our study adds evidence as to the disparities in health-care utilizations and costs over the course of illness, in outcome ratios, and between genders, for both AN and BN.
Kurzfassung Bei der Planung von Fabriken muss heute von veränderten Rahmenbedingungen ausgegangen werden. Wandlungsfähigkeit und Mobilität der Fabrik bilden die zentralen Ziele, die realisiert werden müssen, um zukünftig wettbewerbsfähig zu bleiben. Mit der Digitalen Fabrik wird ein Lösungsweg zur Bewältigung neuer Anforderungen an die Fabrikplanung vorgeschlagen. Die Vision der Abbildung aller planungsrelevanten Facetten einer Fabrik in rechnerunterstützten Modellen ist bislang nicht so umfassend betrachtet worden wie in dem hier vorgestellten Konzept.
Polypharmacy is associated with poorer self-rated health (SRH). However, whether polypharmacy has an impact on the SRH progression is unknown. This study investigates the association of polypharmacy with SRH change in 1428 participants of the Berlin Initiative Study aged 70 years and older over four years. Polypharmacy was defined as the intake of ≥5 medications. Descriptive statistics of SRH-change categories stratified by polypharmacy status were reported. The association of polypharmacy with being in SRH change categories was assessed using multinomial regression analysis. At baseline, mean age was 79.1 (6.1) years, 54.0% were females, and prevalence of polypharmacy was 47.1%. Participants with polypharmacy were older and had more comorbidities compared to those without polypharmacy. Over four years, five SRH change categories were identified. After covariate adjustment, individuals with polypharmacy had higher odds of being in the stable moderate category (OR 3.55; 95% CI [2.43–5.20]), stable low category (OR 3.32; 95% CI [1.65–6.70]), decline category (OR 1.87; 95% CI [1.34–2.62]), and improvement category (OR 2.01; [1.33–3.05]) compared to being in the stable high category independent of the number of comorbidities. Reducing polypharmacy could be an impactful strategy to foster favorable SRH progression in old age.
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